Golden Living Center-Frankfort v. Secretary of Health & Human Services
2011 U.S. App. LEXIS 18180
| 6th Cir. | 2011Background
- Golden Living Center appealed CMS penalties for noncompliance with federal nursing-home participation requirements after an 18-day stay of resident R1, during which dehydration, hyperkalemia, and other complications occurred; state surveys found multiple deficiencies and immediate jeopardy; ALJ upheld penalties and determinations, and the Appeals Board affirmed; the Sixth Circuit affirmed, applying substantial-evidence review.
- R1 arrived Dec 7, 2007 with dehydration risk and complex conditions; R1’s fluid intake was far below dietician-recommended 2170 mL/day; Payton detected pneumonia and ordered tests, but fluids and labs were delays; R1 developed hyperkalemia, was hospitalized, and then returned to Golden where potassium was re-administered; by Dec 25, R1 showed serious deterioration and was hospitalized again; Golden’s care plans and monitoring failed to address hydration, labs, or electrolyte management; CMS concluded immediate jeopardy and substantial noncompliance through March 3, 2008, resulting in total penalties of $172,150.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Standard of review applied to agency findings | Golden argues de novo review misapplied; asserts improper weighing of evidence | CMS asserts substantial-evidence review with deferential standard | Standard of review proper; substantial evidence supports findings |
| Hydration requirement violation | Golden contends complexity and hydration risk justified limited fluids | Facility failed to provide 2170 mL/day and monitor intake | Substantial evidence supports hydration violation under §483.25(j) |
| Laboratory services violation | Delays in tests overstated by CMS | Delays not decisive | Substantial evidence supports failure to provide timely lab services under §483.75(j)(1) |
| Comprehensive care plan violation | Care plans were tailored but not specific to R1's needs | Plans complied with general requirements | Substantial evidence supports failure to provide resident-specific, measurable care plans under §483.20(k) |
| Immediate jeopardy finding and duration | Argues jeopardy not shown or duration improper | Findings supported by record; duration reasonable given risk to others | Immediate jeopardy found not clearly erroneous; penalty duration upheld |
Key Cases Cited
- Claiborne-Hughes Health Ctr. v. Sebelius, 609 F.3d 839 (6th Cir.2010) (substantial-evidence review; deference to agency findings)
- MeadowWood Nursing Home v. United States Dep't of Health & Human Servs., 364 F.3d 786 (6th Cir.2004) (substantial evidence standard of review)
- Woodstock Care Ctr. v. Thompson, 363 F.3d 583 (6th Cir.2003) (highly deferential review of agency decisions)
- Universal Camera Corp. v. NLRB, 340 U.S. 474 (1951) (scope of substantial evidence review guidance)
- Lakeridge Villa Health Care Ctr. v. Leavitt, 202 Fed.Appx. 903 (6th Cir.2006) (relationship of deficiencies in penalties)